APPLING MIDDLE SCHOOL BAND BOOSTERS

Individual Student Account (ISA)

CHARGE AUTHORIZATION FORM

I, _______________________________, authorize Appling Middle School Band Booster's Treasurer to charge the following expenses to the Individual Student Account of my child,______________________________________.

Itemized expenses to be withdrawn from my child's ISA:

        ________________________________________________                              $_________________________

        ________________________________________________                              $_________________________

        ________________________________________________                              $_________________________

Signed:________________________________________________________

Date:__________________________________________________________

Phone:_________________________________________________________

                                                                                                       ___________________________________

                                                                                                                                       For Treasurer Use Only:

                                                                                                                                                                                                                           Date Applied

                                                                                                                                                                                                                            _____________